Substance-Induced Mood Disorder
DSM-IV Diagnostic Criteria A'''. A prominent and persistent disturbance in mood predominates in the clinical picture and is characterized by either (or both) of the following: # depressed mood or markedly diminished interest or pleasure in all, or almost all, activities # elevated, expansive, or irritable mood '''B. There is evidence from the history, physical examination, or laboratory findings of either (1) or (2): # the symptoms in Criterion A developed during, or within a month of, Substance Intoxication or Withdrawal # medication use is etiologically related to the disturbance C'''. The disturbance is not better accounted for by a Mood Disorder that is not substance induced. Evidence that the symptoms are better accounted for by a Mood Disorder that is not substance induced might include the following: * the symptoms precede the onset of the substance use (or medication use) * the symptoms persist for a substantial period of time (e.g., about a month) after the cessation of acute withdrawal or severe intoxication or are substantially in excess of what would be expected given the type or amount of the substance used or the duration of use * there is other evidence that suggests the existence of an independent non-substance-induced Mood Disorder (e.g., a history of recurrent Major Depressive Episodes) '''D. The disturbance does not occur exclusively during the course of a delirium. E'''. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. '''Note: This diagnosis should be made instead of a diagnosis of Substance Intoxication or Substance Withdrawal only when the mood symptoms are in excess of those usually associated with the intoxication or withdrawal syndrome and when the symptoms are sufficiently severe to warrant independent clinical attention. Specify type: * With Depressive Features: if the predominant mood is depressed * With Manic Features: if the predominant mood is elevated, euphoric, or irritable * With Mixed Features: if symptoms of both mania and depression are present and neither predominates Specify if: * With Onset During Intoxication: if the criteria are met for Intoxication with the substance and the symptoms develop during the intoxication syndrome * With Onset During Withdrawal: if criteria are met for Withdrawal from the substance and the symptoms develop during, or shortly after, a withdrawal syndrome Subtypes and Specifiers Subtypes One of the following subtypes may be used to indicate which of the following symptom presentations predominates: With Depressive Features This subtype is used if the predominant mood is depressed. With Manic Features This subtype is used if the predominant mood is elevated, euphoric, or irritable. With Mixed Features This subtype is used if the symptoms of both mania and depression are present but neither predominates. Specifiers The context of the development of the mood symptoms may be indicated by using one of the following specifiers: With Onset During Intoxication This specifier should be used if criteria for intoxication with the substance are met and the symptoms develop during the intoxication syndrome. With Onset During Withdrawal This specifier should be used if criteria for withdrawal from the substance are met and the symptoms develop during, or shortly after, a withdrawal syndrome. Recording Procedures The name of the Substance-Induced Mood Disorder begins with the specific substance or somatic treatment (e.g., cocaine, amitriptyline, electroconvulsive therapy) that is presumed to be causing the mood symptoms. The name of the disorder (e.g., Cocaine-Induced Mood Disorder) is followed by the subtype indicating the predominant symptom presentation and the specifier indicating the context in which the symptoms developed (e.g., Cocaine-Induced Mood Disorder, With Depressive Features, With Onset During Withdrawal). When more than one substance is judged to play a significant role in the development of mood symptoms, each should be listed separately (e.g., Cocaine-Induced Mood Disorder, With Manic Features, With Onset During Withdrawal; Light Therapy-Induced Mood Disorder, With Manic Features). If a substance is judged to be the etiological factor but the specific substance or class of substances is unknown, the category Unknown Substance-Induced Mood Disorder may be used. Specific Substances Mood Disorders in association with intoxication with the following classes of substances: alcohol; amphetamine and related substances; cocaine; hallucinogens; inhalants; opioids; phencyclidine and related substances; sedatives, hypnotics, and anxiolytics; and other or unknown substances. Mood Disorders can occur in association with withdrawal from the following classes of substances: alcohol; amphetamine and related substances; cocaine; sedatives, hypnotics, and anxiolytics; and other or unknown substances. Some of the medications reported to evoke mood symptoms include anesthetics, analgesics, anticholinergics, anticonvulsants, antihypertensives, antiparkinsonian medications, antiulcer medications, cardiac medications, oral contraceptives, phychotropic medications (e.g., antidepressants, benzodiazepines, antipsychotics, disulfiram), muscle relaxants, steroids, and sulfonamides. Some medications have an especially high likelihood of producing depressive features (e.g., high doses of reserpine, corticosteroids, anabolic steroids). Note that this is not an exhaustive list of possible medications and that many medications may occasionally produce and idiosyncratic depressive reaction. Heavy metals and toxins (e.g., volatile substances such as gasoline and paint, organophosphate insecticides, nerve gases, carbon monoxide, carbon dioxide) may also cause mood symptoms. Differential Diagnosis Substance Intoxication and Withdrawal Mood symptoms occur commonly in Substance Intoxication and Substance Withdrawal, and the diagnosis of the substance-specific intoxication or substance-specific withdrawal will usually suffice to categorize the symptom presentation. A diagnosis of Substance-Induced Mood Disorder should be made instead of a diagnosis of Substance Intoxication or Substance Withdrawal only when the mood symptoms are judged to be in excess of those usually associated with the intoxication or withdrawal syndrome and when the mood symptoms are sufficiently severe to warrant independent clinical attention. For example, dysphoric mood is a characteristic feature of Cocaine Withdrawal. Cocaine-Induced Mood Disorder should be diagnosed instead of Cocaine Withdrawal only if the mood disturbance is substantially more intense than what is usually encountered with Cocaine Withdrawal and is sufficiently severe to be a separate focus of attention and treatment. Delirium If substance-induced mood symptoms occur exclusively during the course of a delirium, the mood symptoms are considered to be an associated feature of the delirium and are not diagnosed separately. Other Substance-Induced Disorders In substance-induced presentations that contain a mix of different types of symptoms (e.g., mood, psychotic, and anxiety symptoms), the specific type of Substance-Induced Disorder to be diagnosed depends on which type of Substance-Induced Disorder to be diagnosed depends on which type of symptoms predominates in the clinical presentation. Primary Mood Disorder A Substance-Induced Mood Disorder is distinguished from a primary Mood Disorder by the fact that a substance is judged to be etiologically related to the symptoms. A Substance-Induced Mood Disorder due to a prescribed treatment for a mental disorder or general medical condition must have its onset while the person is receiving the medication (e.g., antihypertensive medication) (or during withdrawal, if there is a withdrawal syndrome associated with the medication). Once the treatment is discontinued, the mood symptoms will usually remit within days to several weeks (depending on the half-life of the substance and the presence of a withdrawal syndrome). If symptoms persist beyond 4 weeks, other causes for the mood symptoms should be considered. Mood Disorder Due to a General Medical Condition Because individuals with general medical conditions often take medications for those conditions, the clinician must consider the possibility that the mood symptoms are caused by the physiological consequences of the general medical condition rather than the medication, in which case Mood Disorder Due to a General Medical Condition is diagnosed. The history often provides the primary basis for such a judgement. At times, a change in the treatment for the general medical condition (e.g., medication substitution or discontinuation) may be needed to determine empirically for that person whether the medication is the causative agent. If the clinician has ascertained that the disturbance is due to both a general medical condition and substance use, both diagnoses (i.e., Mood Disorder Due to a General Medical Condition and Substance-Induced Mood Disorder) may be given. When there is insufficient evidence to determine whether the mood symptoms are due to a substance (including a medication) or to a general medical condition or are primary (i.e., not due to either a substance or a general medical condition), Depressive Disorder Not Otherwise Specified or Bipolar Disorder Not Otherwise Specified would be indicated. DSM-5 In DSM-5, this disorder is separated into Substance/Medication-Induced Depressive Disorder and Substance/Medication-Induced Bipolar and Related Disorder